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Last week was a rather hectic week in Ghana. My story of the week was the 'presidential peacock story'. Where are the peacocks that once graced the presidential gardens in the castle by the sea, no, not the stool-like palace by the church? "Who stole the peacocks from the President's Garden? "Was it you?" "No, it wasn't me", "Then who took the peacocks, from the President's garden?" Like KSM says, 'Only in Ghana!' It's only in Ghana that such peacock stories will gain national prominence. Meanwhile, while some busy body journalists were looking for peacocks in somebody's garden and interrogating officers who fed the peacocks, the Planned Parenthood Association of Ghana (PPAG) was also in full gear with the Population Caucus of Ghana's Parliament about the inadequacy of family planning services in Ghana. The Population Caucus is made up of very conscientious men, committed to addressing population issues in Ghana. I did not see any female Parliamentarian at the meeting. It is internationally acknowledged that progress towards achieving Millennium Development Goal No. 5 has stalled, and has been slow and uneven. By adopting the MDG Goal No.5, UN state parties have agreed to reduce the rate of women dying from pregnancy related causes by 75 per cent, and to guarantee free access to reproductive health care by 2015. Ghana has faced challenges in guaranteeing free access to reproductive health care and this is aptly captured in the 2007 Annual Report of the Reproductive and Child Heath Department of the Ghana Health Service. It states in its executive summary that 'funding for contraceptive requirements remains a challenge. Funding was covered by the Ministry of Health and partners. There was a decline in Ministry of Health's contribution and the introduction of new sources of funding.' Commitment and support for family planning from the highest levels of government has not been very visible compared to commitment to issues of malaria and HIV and AIDS. What are the issues? Our citizens know about family planning and contraceptives, but few people use contraceptives. There is also a rural/urban gap where more women. in the south use contraceptives than women in the three northern regions. This has implications for population growth, development, poverty and maternal mortality. Ghana's population for example is expected to double in the next 26 years and the population growth still remains at 2.7 per cent. Population growth has slowed down from three per cent in 1970 to 2.7 per cent in 2008. This will undermine our national development objectives. Article 37 (4) of the 1992 Constitution, under the Directive Principles of State Policy, places an obligation on Ghana as a state party to international population policies to maintain a population policy that is consistent with the aspirations and development needs and objectives of Ghana. This objective will not be achieved if our population growth spirals out of control as is envisaged. Ghana is also plagued with maternal deaths, and though the existence of major obstacles to safe motherhood is not unique to Ghana, interventions to address maternal mortality (MM) in Ghana have not been encouraging. The current rate is 560/100,000 live births per year as per the 2007 Report. In Ghana, 14 per cent of women die from maternal causes. Some will survive, but suffer from childbirth and pregnancy disabilities. Unplanned and mistimed pregnancies contribute to II per cent of women dying from pregnancy-related causes. These pregnancies are preventable and some are unwanted. How do we address the unmet needs of married and young women who want to space their next birth or stop having children altogether but are not using contraceptives? The unmet need for women who want to stop childbirth or space their children is still high and has rather increased from 34 per cent in 2003 to 36 per cent in 2008. In 2003, 14 per cent of adolescents had already started childbearing. What family planning services were made available to them. The number of women using modem methods of contraceptives increased from six per cent in 1988 to 19 per cent in 2003, but has dropped to 17 per cent in 2008. Why do we have this situation? One of the reasons is the availability of family planning services. The provision of family planning services is a state function and is supposed to be resourced by the state. Ghana was one of the first African countries to start a family planning programme in 1970 since it recognised family planning as a means for development. This influenced planning and delivery of family planning services in Ghana. Over the years, however, priority given to FP slipped and this led to a policy intervention in 2004 by the Ghana Health Service and other health advocates where a road map for repositioning family planning was adopted for 2006 to 2010. Unfortunately, family planning has been ignored as a public health priority and is underfunded. There are serious resource constraints plaguing availability and funding for contraceptives by the Government of Ghana. A comprehensive report on the estimate of potential costs and benefits to adding family planning to the NHIS has been prepared by a team of experts, and references have been made to the report in this paper. The cost of family planning commodities for instance far exceeded the budget in the 2008 programme of work. It left a funding gap of over $7 million for family planning commodities. Though our development partners have encouraged the government to assume a greater share of costs of, a shortage in 2007 on contraceptive commodities had to be addressed by the development partners. At the current levels of funding, the Ministry of Health will not be able to achieve its goals in reproductive health. Contraceptives are provided to the Ghana Family Planning programme through donations from USAID, United Nations Population Fund (UNFPA), UN Department for International Development (DFID) and others with MOH contributing 21 per cent of the funding of total costs. Future needs for contraceptives funding total over $35 million from 2008 to 2011, but only 4.2 million has been committed by Danish International Development Agency (DANIDA), USAID and Ministry of Health so far. Placing family planning as a public health priority would be highly beneficial to Ghana. It will reduce Maternal Mortality and help us achieve MDG 5 in 2015. It has been proved that there is a relationship between obstetric services and maternal mortality. In Bangladesh for example, though 90 per cent of deliveries continue to take place at home and by unskilled birth attendants, the maternal mortality ratio has fallen by 22 per cent over 12 years. This progress is attributable to an increase in contraceptive use that has resulted in a decline in fertility and unplanned pregnancies. It is estimated that in 2000, 90 per cent of abortion related and 20 per cent of obstetric related mortality and morbidity globally could have been averted by the use of effective contraception by women wishing to postpone or cease further child bearing. In sub-Saharan Africa and Ghana, use of modem contraceptive methods continue to be low. One strategic and unique opportunity for addressing this dire situation presents itself with the introduction of the National' Health Insurance Scheme. The NHIS Act was passed by Parliament in 2003. The Act is to secure provision of basic health care services in Ghana through mutual and private health insurance schemes. The National Health Insurance Regulations were adopted in 2004, and Regulation 19 (4) provides that public health services shall be paid for by the government and shall be free, Under Part 3 of the Schedule, family planning is listed as one of the public health care services that the State is to provide free of charge. In reality, however, what happens at our health care facilities throughout the country? In actual practice, almost every public facility and private facility charge fees for family planning products. The charges are relatively low for short term methods, but are higher for long term methods like Intra Uterine Device (IUD). These charges serve as a financial barrier to the woman who wants to avoid an unwanted pregnancy. A woman who registers for health insurance will receive free ante-natal and delivery care, free care for her baby and all costs relating to maternity but will have to pay fees to obtain family planning services. This I believe is a disincentive for women and the overall constitutional objective to reduce our growth rate in Ghana. While the fee charged for FP commodity is nominal, that is, 10 per cent, it still acts as a barrier to access FP services and could account for the low prevalence of contraceptive use. If family planning is included in the coverage of national health how will this help? It will cause a decrease in fertility and avert births that would otherwise cost the NHIS considerable expenses. It will lead to annual net savings to the NHIS that would increase over time. If FP is covered in 2009 for example, by 20 11, NHIS will realise almost GH� II million in net savings for that year alone. This will increase to over GH�18 million in 2017. It is therefore recommended that Parliament amends the National Health Insurance Regulations, 2004, to include the coverage of FP services. It will help us realise our population's objectives, reduce MM and increase development in Ghana. Mr Sylvester Mensah, Director-General of the National Health Insurance Authority, please support the campaign for inclusion of family planning in the National Health Insurance Scheme so that condoms become freely available for you and me. Condoms and not peacocks, please.